WEDNESDAY, Oct. 28, 2020 — Many aspects of daily living can trigger stress. But for Black women, everyday stressors plus racial discrimination and a specific genetic mutation may increase the risk for obesity, diabetes and heart disease, researchers say.

The EBF1 mutation is found in roughly 2% of Black women and 7% of white people. And according to study co-author Abanish Singh, it has previously been linked to high blood pressure concerns.

“There may be many pathways for the development of obesity and cardiometabolic disease in Black women,” said Singh, an assistant professor at Duke University School of Medicine, in Durham, N.C. But this finding “suggests one more such pathway, whereby in those with the risk mutation there was a larger increase in central obesity, glucose [blood sugar] and the presence of type 2 diabetes, a strong risk factor for cardiovascular disease.”

For the study, Singh’s team analyzed stress profiles and genetic predispositions of about 28,000 Black and white men and women.

This study comes on the heels of a much smaller 2014 investigation (conducted by the same team) that enlisted about 5,800 white, Black, Asian and Hispanic women. It too focused on the EBF1 mutation, and how it affected women’s health when combined with stress.

The earlier result showed a rise in metabolic and heart health concerns among white women, but not Black women.

However, the 2014 effort had not included racial discrimination among possible stress factors such as work, finances and relationships. The current study does. And “this effect of carrying the risk mutation was also observed in Black women only if the stress measure included racism, discrimination and unmet basic needs,” said Singh.

That, he said, suggests the importance of considering “stressors relevant to the life situation of each race.”

But how exactly do genetics and life stress team up to affect health?

It could be that the combination leads people to develop poor dietary habits, or to engage in a less active lifestyle, said Singh. Or perhaps the combo triggers metabolic changes that undermine the efficient processing of fat and blood sugar. “Our observations represent early findings that will require much more study,” he cautioned.

But what is clear is that it’s the combination of stress and the gene mutation that causes the problem, so that “if either or both of the players is missing, the interplay does not lead to the observable risks,” Singh said.

Can women lower their risk?

“The genetic variant is certainly not an individual’s choice,” said Singh, “and neither is systemic racism.” But he suggested that regardless of race, women would do well “to adopt a lifestyle that includes improved diet and exercise habits, and training in coping skills that can reduce the impact of daily-life stress.

Andrea Roberts is a senior research scientist at the Harvard T.H. Chan School of Public Health, in Boston. She cautioned that the study only explored the interaction of stress with a single genetic variant. “For most health outcomes, including cardiovascular outcomes and obesity, there are likely hundreds or thousands of genes that influence risk,” Roberts said.

“So, I don’t find it that informative that the study found a gene-environment interaction looking at a single gene,” she added.

Still, Roberts noted that “it is not at all surprising that discrimination is a major stressor for Black women, and would increase their risk of heart disease.”

She agreed that a healthy, supportive lifestyle is imperative for optimal health. “Black women and people in general who are experiencing a lot of stress — which is most of us these days — can engage in healthy behaviors that combat stress, including daily exercise, meditation and yoga.” Maintaining friendships and other relationships can be beneficial, too, she said.

Helping others can pay off as well. “Becoming involved in public service and volunteering has been shown to turn one’s orientation outward and reduce stress,” Roberts added. “People may also find it helpful to become involved in antiracist activities and groups.”

The study findings were published online Oct. 20 in Translational Psychiatry.

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